Living
Donors Online!

Have questions about
living kidney donation?

There is a considerable
amount of information about living kidney donation on this site. Click here
to get started. You can also find answers to questions on the Links
page. You can read about the experiences of other living kidney donors
on the Experiences
page.

Here are additional
questions based on actual questions to Living Donors Online!:

A1: What
is the process for determining whether I can donate a kidney?
The short answer is you need to show three things: (1) you have blood
and tissue types compatible to the recipient, (2) you are generally
healthy, and (3) you have two healthy kidneys. You might also undergo
psychological and financial assessments. For more information, check
out this page.

A2: What are the long-term
effects on me if I donate one of my kidneys?
Frankly, there is inadequate medical research on the long-term
consequences of living donation, and some of the research available is
limited in scope (e.g., one transplant center) or does not follow
statistically rigorous procedures (e.g., inadequate sampling). The
research currently available has shown there are few, if any, long-term
effects on a living
kidney donor. Mortality rates look to be the same or better than the
general population. Some studies have revealed slightly higher
incidence of high blood pressure and
elevated levels of protein in the urine. There is also a possibility
(0.1% to 1.1%) that a living kidney donor will develop End Stage Renal
Disease and need a kidney transplant. This page
describes the research results more completely. However, much more
rigorous research is needed to answer this question with confidence.

A3: I've been asked to donate
but I just don't want to do it. What should I do?
The decision whether or not to donate ultimately is yours. TDo not
let people pressure you to donate. Next, make sure you have
all the information you need to make an educated decision. There's
information on LDO and on the links. Ask questions in the LDO
Community
Message Forum. If you are frightened of things you don't understand,
then seek out the information that helps you understand. If you decide
not to donate and are concerned about the reaction of friends and
family, talk to the social worker or psychologist on the transplant
team. They will be able to help you work out a way of declining
gracefully.

A4: I have a friend who needs
a kidney and I'd like to donate but I'm not related. Is that OK?
Yes. In the past, the conventional wisdom was that close tissue typing
was necessary for a successful donation, and close tissue typing
implied blood relationships. However, anti-rejection drugs are so powerful
now that close tissue typing is less important when identifying a potential donor. Consequently, unrelated
living donation has increased dramatically over the last 10 years. You
will still need to go through the normal evaluation of donors (see this
page).
Also be prepared to discuss your motives for donation and the impact it
might have on your relationship with the recipient and family.

A5: I need money and I'd like
to donate one of my kidneys. Can I do this?
No. Here's what Dr. Jeff Punch of University of Michigan says on the
Transweb site: "Paid donation is illegal in the United States, Britain,
Canada, Mexico, and all of Europe. In India, paid organ donation has
been tolerated in the past, but the government there has passed a
resolution intended to eliminate the practice. To date, no reputable
organization pays for human organs anywhere in the world. Although paid
donation may occur in some parts of the world, the lack of
accountability of the unscrupulous individuals who engage in this
practice means it is unsafe to either donate a kidney through such an
organization or purchase a kidney in this way." In the US it is
possible for a donor to reimbursed by the recipient for travel,
housing, and lost wages related to the donation. The US law can be
found here.

A6: I'm ready to donate. Who
pays?
The transplant recipient's medical insurance (including US Medicare) covers the cost of the
donor's testing, surgery, and recovery in the hospital. You are on your
own as far as lost wages if you miss work for testing and surgery, but most enlightened
employers cover this time off with sick leave and vacation pay.
Alternatively, you might qualify for unpaid leave. Some progressive employers, such as United Network for Organ Sharing
and some state governments, have arranged for paid leave specifically
for living donors. Talk to your employer about the types of time-off
benefits available to you.

Generally, any medical treatment needed following the donation, such as
annual
physical exams, are your responsibility. However, complications
directly related to the donation should be covered by the transplant
center. Note that some living donors have found themselves charged for
these expenses. It is the position of LDO that donors should not pay
for the treatment of complications from living donor surgery. Please contact us if you find you are being charged for these expenses.

A7: What are the odds my
donated kidney will work...that it won't be rejected?
Excellent. In fact, living kidney donation has the best track record of
all forms of donation. Statistics from the Organ Procurement and
Transplant Network show that the kidney donated from living donors is
still functioning in
96% cases after one year, 81% of cases after five years, and 58% of
cases after 10 years. Even so,
you should be prepared mentally for the possibility of rejection.

A8: I've got lots of
questions about donating. Who should I talk to?
The first place to go is the transplant team. Talk to the transplant
coordinator, the surgeon, the social worker, or
whomever you are most comfortable with. You should also consider
talking with friends, family, religious leaders, and others you trust.
You can also ask questions here on the LDO! Message Board.

A9: I'm a female considering
donation but I'd also like to have children after donation. What effect
does donation have on pregnancy?
The United Kingdom Guidelines for Living Donor Kidney Transplantation,
published in January 2000, reviews two research reports and draws this
conclusion: "The presence of a solitary kidney does not appear to pose
a significant risk during the course of a normal pregnancy." Check the
Links page for a link to the UK site with the complete text of the
guidelines for more information and citations of the research papers.

Also, LDO! received this message from a female living kidney donor
about the special steps taken during the donation process and her
actual post-donation experience with pregnancy:

"Pregnancy was my big
concern with planning the transplant. They removed the right kidney
because they told me that that was the one that was the most stressed
by pregnancy. They also took it from the front and didn't use staples
on my scar. They used steri-strips.

As far as when I was
actually pregnant the only thing my doctor did was do a 24-hour urine
catch to check output. Everything was just fine. She told me there
wasn't any reason to be concerned about just the one kidney. I didn't
have any problems at all."

An abstract of research on this subject appeared in Transplantation 62
(12) 1934-1936, Dec 1996, regarding the risks of pregnancy after a
living kidney donation: "Potential female donors frequently ask whether
unilateral nephrectomy will impair future childbearing capabilities. To
address this question, we surveyed 220 women who underwent donor
nephrectomy between 1985 and 1992. Of the 144 women who responded, 33
became pregnant after donation for a total of 45 pregnancies.
Seventy-five percent of the pregnancies were carried to term without
difficulty. Complications incurred during gestation included
miscarriage (13.3%), preeclampsia (4.4%), gestational
hypertension(4.4%), proteinuria (4.4%), and tubal pregnancy (2.2%).
Four of the 45 pregnancies (excluding miscarriages) required preterm
hospitalization, resulting in an overall morbidity of 8.8%. There were
no pregnancy-related deaths, and no fetal abnormalities were reported.
Problems with persistent hypertension, proteinuria, or changes in renal
function were not noted. None of the above complications exceeded what
has been noted for the general population. Infertility was a problem in
8.3% (3/36) of our respondents, compared with a worldwide incidence of
16.7%. Based on these results, we
conclude that donor nephrectomy is not detrimental to the prenatal
course or outcome of future pregnancies
(emphasis added)."

Finally, a study in Norway linking data from their living
donor registry to birth records found living donor women with a higher
incidence of preeclampsia (5.7%, versus 3.5% for a randomly selected
group).

Be sure to talk with your obstetrician or gynecologist about your
interest in donation and the effect it could have on future pregnancies.

A10:
HLA (Human Leukocyte Antigen) matching is used for kidney donation. It is a means for determining
how well your tissues match the recipient and, therefore, reduce the
chance of rejection. Generally, HLA matching looks at six primary
antigens. A perfect match is sometimes referred to as a "six out of
six." A zero match is "zero out of six."

Improvements in anti-rejection drugs have made HLA matching less
important. (You must still match blood type and pass the crosstest,
among other screens.) That's good news because the potential donor pool
increases to include people who are not strong HLA matches.

However, data from the Organ Procurement and Transplant Network (OPTN) indicate
there is a positive relationship between the level of HLA matching and
the historical survival rates of the patient and the donated organ
(called a "graft"). The data indicate, given a choice, a transplant recipient would
prefer a living donor kidney to a deceased donor kidney regardless of the HLA
matching level. Also, to the extent possible, the patient should seek
the best HLA match possible.

Even so, a patient and his or her transplant team need to weigh the
health impact of taking a poorly matched organ against alternative
forms of treatment such as dialysis.

A11.
You should ask your doctor for guidance. Other living kidney donors
report that they are advised to avoid or at least minimize use of
medications that can be toxic to kidneys. A common example is
ibuprofen, which is the main ingredient in pain relievers like Advil.
Other examples and explanations can be found here.

A12.
One of the first tests for living donors is determining whether the
donor and recipient have compatible blood types. If they are not
compatible, because of ABO incompatibility or a positive crossmatch,
there are a couple of alternative ways to donate.

One option is a new procedure called plasmapheresis. In general, this
procedure involves a process similar to dialysis to remove the plasma,
where the antibodies reside, from the recipient's blood. The
recipient's spleen, where antibodies are produced, is also removed.
This procedure is considered experimental by some insurance companies,
so insurance coverage may be limited. Check with the medical insurer to
confirm that plasmapheresis is a covered procedure. You can learn more
about this process at there web sites (these links may expire):

Another option is "paired
exchange." In this situation, you
find another pair of people--a potential donor and recipient--where the
donor is compatible with your recipient and you are compatible with
their recipient. You can learn about paired exchange here: paired
exchange.